He Pou Whirinaki (Pillars of Support). Elder Indigenous New Zealand Māori Narratives about Influenza Immunisation and the Use of Telehealth during the First COVID-19 Lockdown

"These findings describe ways in which local elders and communities found ways in the COVID-19 pandemic to provide pillars of support (He Pou Whirinaki), for each other and utilise new ways of interconnecting."

Equitable access to health care for Māori, the indigenous people of New Zealand, is a concern. In past influenza epidemics, Māori have been especially severely affected; in 2019, influenza vaccination coverage for older Māori was 45% vs. 57% overall. There was concern that in 2020, especially due to the COVID-19 lockdown situation in place at the start of the influenza season, it may have been difficult, particularly for some elderly Māori, to access influenza vaccination. This paper describes issues, strengths, and challenges experienced by elderly Māori accessing influenza vaccination during the COVID-19 lockdown in 2020. It also explores their attitudes about future COVID-19 vaccines, their perceptions on vaccination more generally, and their experiences with using technology to connect with others in light of the social restrictions created by the lockdown.

Kaumātua are Māori elders who have important responsibilities within their whānau (extended family) or community. They have great respect within a Māori community and are understood to speak in many instances not just for themselves but for their community. Participants in the study were four kaumātua - two men, two women - aged between 66 and 86 who had been recruited via health sector network connections. Interviews were conducted between August 20 and September 3 2020.

The narratives highlighted an awareness of the generational impact of illness and vaccination and concern about the impact of COVID-19 on vulnerable populations. They were acutely aware of their vulnerability to influenza (along with COVID-19) due to their age, and they described the benefits of vaccines to counter illnesses such as polio. All four respondents indicated the significant role of prompts and/or endorsements from health professionals and government for people to get vaccinated. The well-developed views of these Māori kaumātua about influenza, vaccination, and COVID-19 occurred within an environment of contrasting health beliefs and trust/distrust about government and the Pākehā-led (NZ European) clinics rather than the iwi-led (trial) health service. There was support for the style and content of local health services and recognition and that Pākehā-led health services can be effective when complemented by traditional Māori health values approaches and beliefs.

Although there was a significant amount of initial anxiety engendered by the restrictions of lockdown and the impact on usual means of contact and communication, respondents affirmed the many advantages that tight-knit community cohesion made on the response to the COVID-19 pandemic. During and soon after the lockdown and particularly as conditions eased a little, there was a significant amount of local organisation and community caring that occurred. Linked to this caring was an enhanced recognition of the "wisdom of the elders" (and resultant empowerment), as, for example, messages and advice were sent to younger family members in urban areas on how to grow food.

A striking feature of the narratives was the way Maori elders were able to adjust to the increased use of new technologies. In te reo Māori (the Māori language), a meeting is called a hui, and up to 40-50 elders met on Zoom (or 'Zui', as it came to be known) to discuss hapū/iwi business or simply to connect and talk to each other. The facility and fluency with which this group of elders adopted and engaged virtual meetings and communication aligns with Māori values of whakawhanaungatanga (building/maintaining relationships) and manaakitanga (hospitality), as well as their roles of kaumātua. That is, the technology allowed kaumātua to connect with whānau, communities, and health providers to take care of themselves and others and to exchange advice and wisdom across generations. The findings highlight ways in which local elders and communities found ways in the COVID-19 pandemic to provide pillars of support (He Pou Whirinaki) for each other, thanks to their adjustment to and affinity for new ways of interconnecting.

Thus, this study reveals that Māori kaumātua have a well-developed view of the impact of COVID-19, influenza, and other vaccine-preventable diseases on their communities. They see the importance of collective community response, which includes engagement in Western health, such as use of vaccination, to support their communities. They recognise that Māori and Pākehā worldviews can complement each other and that use of Pākehā health services can coexist with traditional approaches and beliefs. Health services that are responsive and engaged can be highly valued but there is also risk of conflict, creating a sense of disconnect and mistrust.

In conclusion: "The narratives and learnings obtained from these preliminary insights provide a platform for further research of this nature where further information can be obtained about the significant amount of community resilience to be celebrated and nurtured. It is important to acknowledge the potential for elders in a community to be engaged in the solutions to local problems and acknowledge their resilience and fluent adoption of new technologies."